Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules

Park, Chul Hwan; Han, Kyunghwa; Hur, Jin; Lee, Sang Min; Lee, Ji Won; Hwang, Sung Ho; Seo, Jae Seung; Lee, Kye Ho; Kwon, Woocheol; Kim, Tae Hoon; Choi, Byoung Wook

doi:10.1016/j.chest.2016.09.017

Cited by 238 publications

(312 citation statements)

References 51 publications

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“…16 The mean success rate of HWL is reported as 0.98 (95% confidence interval 0.97-0.99). 17 In our case, the success rate was 100%, which was consistent with the rate reported by Gruber-Rouh et al 18 Dislodgement is a major disadvantage of the HWL procedure. The hook-wire dislodgement rate is reported as 0-6.9%.…”

Section: Discussionsupporting

confidence: 91%

Ultralow dose computed tomography protocol for hook‐wire localization of solitary pulmonary nodules prior to video‐assisted thoracoscopic surgery

et al. 2019

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Background This study prospectively investigated the efficacy and radiation dose of ultralow dose computed tomography (CT)‐guided hook‐wire localization (HWL) at 100 kV with tin filtration (100Sn kV) for small solitary pulmonary nodules. Methods All HWL procedures were performed on a third generation dual‐source CT system. Eighty‐eight consecutive patients undergoing CT‐guided HWL were randomly assigned to standard dose CT (Group A: n = 44; reference 110 kV and 50 mA) or ultralow dose CT (Group B: n =44; 100 Sn kV and 96 mA) protocols. The technical success rate, complications, subjective image quality, and radiation dose were compared between the groups. Results The mean volume CT dose index and total dose‐length product were significantly lower in Group B compared to Group A (0.32 mGy vs. 3.2 ± 1.1 mGy and 12.1 ± 0.97 mGy‐cm vs. 120 ± 40.6 mGy‐cm; P < 0.001). The effective dose in Group B was significantly lower than in Group A (0.17 ± 0.01 mSv vs. 1.68 ± 0.57 mSv, ‐89.8%; P < 0.001). The technical success rates were 100% for both groups. There were no significant differences in complication rates between the protocols ( P > 0.05). The image quality of ultralow dose CT met the requirements for HWL procedure. Conclusion Ultralow dose CT‐guided HWL of solitary pulmonary nodules performed at 100 Sn kVp spectral shaping significantly reduced the radiation dose compared to standard dose CT, with high technical success and acceptable patient safety.

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Section: Discussionsupporting

confidence: 91%

Ultralow dose computed tomography protocol for hook‐wire localization of solitary pulmonary nodules prior to video‐assisted thoracoscopic surgery

et al. 2019

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“…In our study, minor hemorrhage, indicated by small areas of consolidation in the lung window on final CT scan, was found in 3 patients, with no cases of hemoptysis. Meanwhile, the incident rate of pneumothorax was also lower compared with other methods (14). No thoracic closed drainage or thoracic puncture procedures were required.…”

Section: Discussionmentioning

confidence: 86%

A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery

Guo

et al. 2018

Diagn Interv Radiol

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“…However, this technique has several limitations, including pneumothorax (16–35%) and hemothorax (6–16%) [7, 11, 21, 22], as well as dislodgement of the guide wire, which can lead to the failure of localization. A few cases of air embolism have also been reported [22-24].…”

Section: Discussionmentioning

confidence: 99%

“…To date, CT-guided wire placement (including hook wires, microcoils, and spiral wires) is the most common procedure used to localize small, nonpalpable pulmonary lesions, with a high rate of successful localization [11]. However, this technique has several limitations, including pneumothorax (16–35%) and hemothorax (6–16%) [7, 11, 21, 22], as well as dislodgement of the guide wire, which can lead to the failure of localization.…”

Section: Discussionmentioning

confidence: 99%

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Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

et al. 2018

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Background: Minimally invasive surgery of pulmonary nodules allows suboptimal palpation of the lung compared to open thoracotomy. Objective: The objective of this study was to assess endoscopic pleural dye marking using radial endobronchial ultrasound (r-EBUS) and virtual bronchoscopy to localize small peripheral lung nodules immediately before minimally invasive resection. Methods: The endoscopic procedure was performed without fluoroscopy, under general anesthesia in the operating room immediately before minimally invasive surgery. Then, 1 mL of methylene blue (0.5%) was instilled into the guide sheath, wedged in the subpleural space. Wedge resection or segmentectomy were guided by visualization of the dye on the pleural surface. Contribution of dye marking to the surgical procedure was rated by the surgeon. Results: Twenty-five nodules, including 6 ground glass opacities, were resected in 22 patients by video-assisted thoracoscopic wedge resection (n = 11) or robotic-assisted thoracoscopic surgery (10 segmentectomies and 1 wedge resection). The median greatest diameter of nodules was 8 mm. No conversion to open thoracotomy was needed. The endoscopic procedure added an average 10 min to surgical resection. The dye was visible on the pleural surface in 24 cases. Histological diagnosis and free margin resection were obtained in all cases. Median skin-to-skin operating time was 90 min for robotic segmentectomy and 40 min for video-assisted wedge resection. The same operative precision was considered impossible by the surgeon without dye marking in 21 cases. Conclusions: Dye marking using r-EBUS and virtual bronchoscopy can be easily and safely performed to localize small pulmonary nodules immediately before minimally invasive resection.

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Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules

Cited by 238 publications

References 51 publications

Ultralow dose computed tomography protocol for hook‐wire localization of solitary pulmonary nodules prior to video‐assisted thoracoscopic surgery

Ultralow dose computed tomography protocol for hook‐wire localization of solitary pulmonary nodules prior to video‐assisted thoracoscopic surgery

A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery

Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

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